Premium
Phase 1 study of EGFR‐antisense DNA, cetuximab, and radiotherapy in head and neck cancer with preclinical correlatives
Author(s) -
Bauman Julie E.,
Duvvuri Umamaheswar,
Thomas Sufi,
Gooding William E.,
Clump David A.,
Karlovits Brian,
Wehbe Ahmad,
Miller Frank R.,
Kim Seungwon,
Sen Malabika,
Heron Dwight E.,
Grandis Jennifer R.,
Argiris Athanassios
Publication year - 2018
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.31651
Subject(s) - cetuximab , medicine , head and neck squamous cell carcinoma , epidermal growth factor receptor , oncology , egfr inhibitors , cancer , head and neck cancer , phases of clinical research , radiation therapy , cancer research , colorectal cancer , clinical trial
Abstract BACKGROUND Cetuximab combined with radiation therapy (RT) is an evidence‐based treatment for locally advanced head and neck squamous cell carcinoma (HNSCC); however, locoregional failure remains the primary cause of cancer‐related death in this disease. Intratumoral injection of epidermal growth factor receptor (EGFR)‐antisense plasmid DNA (EGFR‐AS) is safe and has been associated with promising lesional responses in patients who have recurrent/metastatic HNSCC. For the current study, the authors investigated the antitumor effects of cetuximab and EGFR‐AS in preclinical HNSCC models and reported their phase 1 experience adding intratumoral EGFR‐AS to cetuximab RT. METHODS Antitumor mechanisms were investigated in cell line and xenograft models. Phase 1 trial eligibility required stage IVA through IVC HNSCC and a measurable lesion accessible for repeat injections. Patients received standard cetuximab was for 9 weeks. EGFR‐AS was injected weekly until they achieved a lesional complete response. RT was delivered by conventional fractionation for 7 weeks, starting at week 3. Research biopsies were obtained at baseline and week 2. RESULTS When added to cetuximab, EGFR‐AS decreased cell viability and xenograft growth compared with EGFR‐sense control, partially mediated by reduced EGFR expression. Six patients were enrolled in the phase 1 cohort. No grade 2 or greater EGFR‐AS–related adverse events occurred. The best lesional response was a complete response (4 patients), and 1 patient each had a partial response and disease progression. EGFR expression decreased in 4 patients who had available paired specimens. CONCLUSIONS In preclinical models, dual EGFR inhibition with cetuximab and EGFR‐AS enhanced antitumor effects. In a phase 1 cohort, intratumoral EGFR‐AS injections, cetuximab, and RT were well tolerated. A phase 2 trial is needed to conduct an extended evaluation of safety and to establish efficacy.